ICU气管插管患者拔管后吞咽障碍康复护理最佳证据总结

Summary of Best Evidence for Rehabilitation Nursing of Post-Extubation Dysphagia in ICU Patients with Tracheal Intubation

目的基于循证方法总结ICU气管插管患者拔管后吞咽障碍(PED)康复护理最佳证据。方法遵照“6S”证据检索模型,检索BMJ Best Practice、UpToDate、国际指南协作网(GIN)、英国国家卫生与临床优化研究所(NICE)网站、苏格兰学院间指南网(SIGN)、美国国立指南网(NGC)、医脉通网站、Cochrane Library、澳大利亚乔安娜布里格斯研究所(JBI)循证卫生保健中心网站、PubMed、Embase、卫生保健及护理学数据库(CINAHL)、中国知网、中国生物医学文献数据库、万方数据知识服务平台中有关ICU气管插管患者PED康复护理相关研究,检索时间为建库至2023年9月。由2名研究人员独立进行文献筛选及资料提取、文献质量评价。结果最终纳入文献12篇,包括专家共识5篇、系统评价4篇、指南2篇、临床决策1篇。最终形成了ICU气管插管患者PED康复护理最佳证据,其包括人员筹备、筛查与评估、基础训练、代偿训练、并发症管理、口腔护理、教育与培训7个类别共32条证据,各证据的等级为1a~5b级,推荐级别为A~B级。结论本研究基于循证方法总结了ICU气管插管患者PED康复护理最佳证据,包括人员筹备、筛查与评估、基础训练、代偿训练、并发症管理、口腔护理、教育与培训7个类别共32条证据。

Objective To summarize the best evidence for rehabilitation nursing of post-extubation dysphagia(PED)in ICU patients with tracheal intubation based on evidence-based methods.Methods According to the"6S"evidence retrieval model,the literature on rehabilitation nursing of PED in ICU patients with tracheal intubation were retrieved from BMJ Best Practice,UpToDate,Guideline International Network(GIN),National Institute for Health and Clinical Excellence(NICE)website,Scottish Intercollegiate Guidelines Network(SIGN),National Guideline Clearinghouse(NGC),Medlive website,Cochrane Library,website of Joanna Briggs Institute(JBI)Evidence-Based Health Care Center in Australia,PubMed,Embase,Cumulative Index to Nursing and Allied Health Literature(CINAHL),CNKI,Chinese Biomedical Database and Wanfang Data.The search time limit was from inception to September 2023.Literature screening,data extraction and literature quality evaluation were conducted independently by two researchers.Results Finally,12 literature was included,including 5 expert consensus articles,4 systematic reviews,2 guidelines,and 1 clinical decision.Finally,best evidence for rehabilitation nursing of PED in ICU patients with tracheal intubation was formed,including 32 pieces of evidence in 7 categories:personnel preparation,screening and assessment,basic training,compensatory training,complication management,oral care,education and training,with the levels of each evidence ranging from grade 1a to grade 5b,and the recommended level from grade A to grade B.Conclusion Based on evidence-based methods,this study summarizes the best evidence for rehabilitation nursing of PED in ICU patients with tracheal intubation,including 32 pieces of evidence in 7 categories:personnel preparation,screening and assessment,basic training,compensatory training,complication management,oral care,education and training.